| NPI | 1992133409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AK 101151) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: AK 6985) |
| Enumeration Date | 2013-10-18 |
| Last Update Date | 2015-07-01 |